Primary Care Redesign for Value-Based Care

Abstract

Summary To address the inefficiencies and high costs associated with the U.S. health care system’s dominant fee-for-service (FFS) model, leaders at Spectrum Health in Michigan — now Corewell Health West — decided in 2019 to undertake a transformation to value-based care, starting with primary care. The aim is to maximize value for patients by achieving the best outcomes at the lowest cost. A set of guiding principles was established to address this primary care initiative: to incorporate population segmentation (clinics tailored to distinct patient cohorts, including healthy, rising risk, high risk, and others); to integrate interdisciplinary care teams (emphasizing top-of-license care); to align physicians’ efforts to their clinical expertise (to create and manage care plans for complex patients); to deliver care through multiple modalities (including virtual care, asynchronous care, home visits, or other ways to meet patient needs); to utilize integrated data and information (facilitated by a robust electronic medical record and analytics capacity to track key performance indicators supporting operational, technical, and clinical workflows); to align provider compensation and incentives with value-based outcomes while shifting away from FFS volume); and to integrate specialty care in primary care (where primary and specialty providers function as members of a joint care team). Recognizing that value-based care delivery typically requires upfront investment and delayed financial ROI, the team effort adopted a two-pronged approach by implementing the value-based care model and simultaneously optimizing primary care FFS. Despite some challenges in meeting all the targeted metrics — including resistance to change management — surveys show improvement in experience scores among patients (rating provider communication and likelihood to recommend the clinic) and well-being scores among physicians and advanced practice providers (lower rates of high distress).